Kasr Al Ainy, the story of a palace that became a medical schoolNadia A El DibJanuary-April 2015, 21(1):1-6DOI:10.4103/1687-4625.155653

Kasr Al Ainy, the palace built by Ahmed Ibn Al Ainy, in the years (A.D.1466-1468) by the Nile shore in the area known till now as Mouth of Khalig. This palace played an important part in the history of Cairo and Egypt which extends till now. It was used as a governmental building, a Chateau, a military hospital and a primary school till the year 1837. Mohamed Ali Pasha introduced the European military system in Egypt and wanted to provide it with the medical aid. He assigned Dr. Clot Bey, from France to establish a medical school in Abu Za'abal to prepare doctors for the army in the year 1827. It was after 10 years that the medical school was transferred to Kasr Al Ainy as a medical school and hospital. Kasr Al Ainy witnessed all the changes that occurred in Egypt till now, serving all the Egyptians and non-Egyptians.

Rationale
The aim of this study is to determine the relationship between metabolic syndrome and the extent of coronary artery disease (CAD) in young adults presenting with acute coronary syndrome.
Background
Metabolic syndrome is associated with subsequent development of type II diabetes mellitus and cardiovascular disease. Individuals with metabolic syndrome are at a higher risk of developing myocardial infarction and CAD.
Patients and methods
This study was carried out at Kasr Al Ainy Hospital at Cairo University and the Sohag Specialized Cardiac and Digestive System Center. One hundred and twenty-two patients presented with acute coronary syndrome during the period of the study from January 2011 to January 2012. Eighty-five were men (69.7%) and 37 were women (30.3%). Patients were classified into two groups according to the presence or absence of metabolic syndrome to determine the effect of metabolic syndrome on severity of coronary lesions in comparison with nonmetabolic patients. Correlation was assessed between the number of metabolic risk components and coronary lesion severity using the SYNTAX score.
Results
The metabolic risk score was determined; patients with a significant metabolic score of at least 3 risk score constituted 66.4% of the total cohort (n = 81 patients).
Patients were subjected to coronary angiography. Totally occluded vessels were found in 33.3% of metabolic syndrome patients and in 26.8% of non metabolic syndrome patients (P < 0.05). The SYNTAX score was used to assess the severity of CAD; it was found to be statistically significantly higher in patients with metabolic syndrome than those without (P = 0.001).
Conclusion
Patients with metabolic syndrome have more severe CADs. Preventive measures against metabolic syndrome and its components are very important and could help avoid the large economic burden of secondary prevention.

Introduction
Coroner autopsies are post-mortem examinations performed at the instance of the law. The aim of this study is to determine the pattern and causes of death in coroner autopsies performed by a police pathologist.
Materials and methods
Autopsy registers and reports of the pathology section of police clinic Benin City, Edo State, Nigeria, from 2008 to 2012 were reviewed with respect to their demographic features, cause and manner of death.
Results
A total of 982 coroner autopsies were performed during the period, involving 773 males and 209 females, yielding a sex ratio of 3.7 : 1. The age group 20-29 years was the most commonly involved, accounting for 28.5% of cases. Accidental deaths were the commonest type of deaths (41.3%), followed by deaths because of homicides (40.8%); natural death was a distant third cause, accounting for 14.6%, whereas suicides and undetermined deaths accounted for 1.2 and 2.1%, respectively. Road traffic accidents were responsible for most accidental deaths (85.7%). Homicidal deaths were mainly by gunshots (66.5% of cases). Cardiovascular system diseases were the leading cause of natural death, with myocardial infarction and complications of hypertension each accounting for 44.4%.
Conclusion
Efforts to reduce road traffic accidents and control the number of guns in the hands of civilians should be intensified. The incidence of myocardial infarction is on the rise and health education is advocated to help reduce its adverse effects.

Background
Mortality and morbidity from chronic heart disease are increasing markedly worldwide. This significant increase was also observed in young adults. Studies carried out in Saudi Arabia have shown that the prevalence of cardiovascular risk factors is high in the young Saudi population.
Objective
Our objective was to compare the prevalence of cardiovascular risk factors in young Middle Eastern medical students aged 18-25 years (Egyptian and Saudi students).
Results
The prevalence of cardiovascular risk factors was high among both Saudi and Egyptian medical students, particularly sedentary life style, obesity, and abdominal obesity. The prevalence of smoking was 29.7% in the two population. Besides a significantly higher prevalence of obesity, abdominal obesity, and reported family history of premature coronary heart disease among the Saudi sample and a significantly higher prevalence of hypertension among Egyptian men compared with Saudi men, the prevalence of risk factors among the two samples did not differ significantly. A relatively high proportion of both samples (23.9% of the Saudi sample and 16.7% of the Egyptian sample) was at an increased risk of developing fatal cardiovascular disease within 10 years.
Conclusion
Besides the higher prevalence of obesity and reported family history of premature coronary heart disease, there was no statistically significant difference between the risk profiles of both samples.

Aim
This study aimed to describe a new method of sulcus fixation of intraocular lenses (IOLs) with total or partial loss of capsular support.
Materials and methods
This was a prospective nonrandomized comparative clinical trial, where two groups were managed for IOL scleral fixation in the absence of capsular support. Group A included 12 cases with classic ab externo two-point sclera fixation and group B included 16 cases with the double rectangular suture sulcus reconstruction (DRSSR). The etiology of aphakia in group A included congenital cataract managed by lensectomy (three cases), trauma (six cases), and complicated phacoemulsification (three cases). In group B, aphakia was because of congenital cataract in two cases, trauma in five cases, hypermature cataract in three cases, and complicated phacoemulsification in two cases. A unique subset of group B included four eyes with posterior chamber IOL subluxation or dislocation managed by DRSSR. The main outcome measures included final best-corrected visual acuity (BCVA), lens stability, and complications.
Results
All 28 eyes had stable or improved BCVA and the mean postoperative BCVA had improved significantly from 6/30 to 6/7.5 (P = 0.004). There were no statistical differences between groups A and B in postoperative BCVA (P = 0.403), complications (P = 0.25), and astigmatism (P = 0.113). Group 2 B cases with subluxated and posterior dislocated IOLs were managed by DRSSR, with no need for exteriorizing the IOL, with excellent centration.
Conclusion
The DRSSR seems to be a safe method of providing an adequate bed for IOL stabilization in the absence of capsular support. This method is particularly useful in dislocated or subluxated IOLs that need repositioning under a closed globe with minimal manipulations.

Background and objectives
Exposure to second-hand smoke is as hazardous as exposure to first-hand smoke, and can cause cardiovascular disease. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a valid negative biomarker of left ventricular (Lv) dysfunction. The current study investigated the effect of exposure to second-hand smoke on serum levels of NT-proBNP, aiming to use NT-proBNP as a screening tool of Lv dysfunction in passive smokers.
Participants and methods
A total of 60 passive smokers and 20 matched controls were enrolled in the study; their ages range from 20 to 35 years. History of cardiovascular or pulmonary disease was an exclusion criterion. Demographic, anthropometric, and passive smoking data were collected through a self-administered questionnaire and physical examination. The extent of passive smoking was assessed by calculating the pack per year history. Serum levels of NT-proBNP were measured using an electrochemiluminescence assay for each participant.
Results
Analysis of data showed that passive smokers were currently exposed to second-hand smoke, 91.7% were living with the smoker, and 8.3% smoker's colleagues. Serum levels of NT-proBNP were 251.2 ± 46.9 and 148.3 ± 29.7 pg/ml in passive smokers and controls, respectively. Also, there was a significant difference (P < 0.0001, 105.4 ± 11.64) in serum NT-proBNP between passive smokers and controls. Serum NT-proBNP was correlated with both the duration and the amount of exposure to second-hand smoke (r = 0.313 and 0.763, P = 0.015 and 0.0001, respectively).
Interpretations and conclusion
These results showed that exposure to second-hand smoke could increase serum levels of NT-proBNP. Accordingly, an elevated NT-proBNP could be a strong predictor of Lv dysfunction in passive smokers.

Background
There are diverse opinions about the degree of adaptability of the respiratory system in delivering the physiological needs in case of tobacco users. Role of the normal respiratory system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. One view holds that the respiratory system is not normally the most limiting factor in the delivery of oxygen; others hold the absence of structural adaptability to physical training as the cause of limitation of the pulmonary system. The role of ventilatory functions in evaluating the respiratory functions in gutkha users has not been studied adequately in previous studies. Hence, there was a need for this study.
Materials and methods
Pulmonary function tests were performed before and after maximal exercise testing to assess dynamic lung functions in two groups: gutkha chewers and nongutkha chewers.
Results
On studying the differences in dynamic lung functions in two groups of nongutkha chewers and gutkha chewers, there was no difference in forced vital capacity and forced expiratory volume in 1 s, before or after exercise testing. The other flow rates maximum mid-expiratory flow, peak expiratory flow rate, and mid-expiratory flow 25-75% were on the higher side in nonchewer individuals, which were consistently maintained after exercise testing. A higher adaptability of the respiratory system to the training stimulus in the form of a higher elastic recoil pressure of the lungs and a lower resistance of medium to small airways is suggested as the mechanism of adaptability in this study.

Exploring the role of population surveys in the health sectorSaurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh RamasamyJanuary-April 2015, 21(1):39-40DOI:10.4103/1687-4625.155671

Globally, health-related information is one of the main pillars of any national health system, which enables policy makers in making evidence-based decisions, planning and resource allocation, program monitoring and evaluation, strengthening of the healthcare delivery system, and development of the community as a whole. In the modern era, different sources of health information have been utilized on the basis of the objective to be fulfilled. However, most of those routine sources do not provide the required comprehensive insights about health and disease in the community, which mark the need for population-based surveys to supplement the routinely collected data and statistics. In conclusion, population-based health survey is an indispensable managerial tool to obtain comprehensive health information, and thus play a crucial role in the strengthening of the healthcare delivery system.